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Year 6 Passmed > Cardio > Flashcards

Cardio Flashcards

1
Q

Revised Jones Major Criteria

A 
Polyarthritis
Pancarditis
Subcut nodules
Erythema marginatum
Sydenham's Chorea
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2
Q

Revised Jones Minor Criteria

A

Arthralgia
Prolonged PR interval
Pyrexia
CRP/ESR

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3
Q

ACEi SFx

A

Cough (15%)
Hyperkalaemia
Angioedema
First dose hypo

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4
Q

HTN regimen <55

A
  1. Ace inhibitor
  2. +Ca blocker
  3. +Thiazide
  4. If K+ <4.5 add Spiro, if not up Thiazides
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5
Q

HTN regimen >55/Afro-Carribean

A
  1. Ca blocker
  2. +ACE inhibitor
  3. +Thiazide
  4. If K+ <4.5 add Spiro, if not up Thiazides
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6
Q

Antiarrhythmics by class + action

A
  1. Procainamide/Flecainide - Na blockade
  2. Beta blockers
  3. Amiodarone - K+ blockade
  4. Verapamil/Diltiazem - Ca2+ blockade
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7
Q

Amiodarone considerations

A 
Long half life
Dirty (CYP450 inh)
Lots of side effects
Proarrhythmic effect
Thrombophlebitic (central vein)
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8
Q

Amiodarone SFx (x7)

A 
Thyroid dysfunction
Thrombophlebitis
Bradycardia (QT elongation)
Corneal deposits
Pulmonary fibrosis
Liver fibrosis
Peripheral neuropathy
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9
Q

Post MI complications

A 
Cardiogenic shock
Cardiac arrest
Heart failure
Tachyarrhythmia
Bradyarrhythmia
Dressler's syndrome 
LV aneurysm
LV wall rupture
VSD
Acute MR
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10
Q

Contraindications to statin use

A

Pregnancy

Macrolide use

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11
Q

HF Rx

A

1st line: ACEi AND B Blockade (start one at a time)
2nd line: ARB/Aldosterone antagonist
3rd line: Cardiac resynchronisation therapy +- digoxin
Furosemide/Spiro for fluid overload
Influenza and pneumococcal vaccines advised

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12
Q

Drugs which improve mortality in stable HF

A

B Blockers
ACEi
Hydralazine with nitrites
Spironalactone

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13
Q

Signs of tricuspid regurg

A

PSM
Pulsatile hepatomegaly
Prominent JVP V waves
Left parasternal heave

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14
Q

Causes of tricuspid regurg

A

RV infarction
Pulmonary hypertension
Rheumatic heart disease
Infective endocarditis

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15
Q

Giant V waves on JVP

A

Tricuspid regurg

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16
Q

Absent A waves on JVP

A

AF

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17
Q

Cannon A waves on JVP

A

Complete heart block/atrial flutter

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18
Q

Posteroinferior MI on ECG

A

ST elevation in 2,3,aVF
Dominant R waves in V1 and V2
3rd degree HB (right coronary supplies AV node)

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19
Q

Arrhythmia Ix?

A

12 lead ECG +- Holter
TFTs
U&Es
FBC

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20
Q

Major GI bleed in pt on Warfarin Rx

A

STOP warfarin
Vit K 5mg IV
Prothrombin complex
Restart warfarin once bleeding stops and INR <5

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21
Q

Acute pericarditis features

A 
Chest pain (better when sitting forwards)
Dry cough
Fever
Tachypnoea
Tachycardia
Pericardial rub
Dyspnoea
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22
Q

Acute pericarditis Rx

A

NSAIDs +- Colchicine for idiopathic/viral cases

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23
Q

Mitral stenosis murmur

A

MDM at the apex.

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24
Q

Mitral stenosis commonest cause

A

Rheumatic heart disease

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25
Q

Mitral stenosis Cx

A

AF
MI
IE
Stroke

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26
Q

Tricuspid regurg murmur

A

PSM at left sternal edge 4th space

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27
Q

Tricuspid regurg common in?

A

IVDU -> tricuspid endocarditis

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28
Q

Most sensitive serum marker of anaphylaxis?

A

Serum tryptase

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29
Q

Most common ECG finding of PE

A

Sinus tachy

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30
Q

PE triad

A

Dyspnoea
Chest pain
Haemoptysis

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31
Q

PE commonest clinical signs

A

Tachypnoea
tachycardia
Pyrexia
Crackles

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32
Q

PE Ix/Rx

A

If Wells <4 then D-Dimer
If Wells >4 then CTPA
+- LMWH
VQ scan done if pt cannot tolerate CTPA (/is allergic to contrast medium)

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33
Q

Most important RF for aortic dissection?

A

Hypertension

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34
Q

Classification system for aortic dissection

A

Stanford classification
Type A - Ascending (2/3)
Type B - Descending (1/3)

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35
Q

NSTEMI ECG Fx

A

ST depression

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36
Q

NSTEMI Rx

A

300mg Aspirine
Nitrates/Morphine
Ticagrelor (preferred to clopi now)
Eptifibatide (GP2bR antagonist)

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37
Q

MI secondary prevention medications (for all patients)

A

B blocker
ACE inhibitor
Statin
DAPT

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38
Q

Diabetic BP targets

A

If end organ damage: <130/80

Otherwise: <140/80

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39
Q

First line antihypertensive in diabetics

A

ACEi (regardless of age or ethnicity) due to renoprotective effects

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40
Q

Type of NIV used in acute heart failure

A

CPAP

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41
Q

Management options in acute heart failure

A 
O2
Furosemide
Opiates
Vasodilators
Inotropes
CPAP
Mechanical circulatory assistance e.g. LVAD
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42
Q

ECG changes in Wolf Parkinson White?

A

PR prolongation
Broad QRS complex with slurred ‘delta’ upstroke
LAD

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43
Q

VT Rx

A 
If symptomatic (shock, MI, HF, syncope): Synchronised DC cardioversion
If asymptomatic: Amiodarone, lidocaine or procainamide
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44
Q

Causes of QT prolongation?

A

Congenital causes

Drug causes:
Amiodarone
TCAs
Class 1a antiarrhythmics
SSRIs
Other causes
Hypokalaemia
Hypocalcaemia
Hypomagnesaemia
Hypothermia
Acute MI
Myocarditis
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45
Q

Coactation of the aorta Fx?

A

HF in infancy
Hypertension in adulthood
Radiofemoral delay
Mid systolic murmur loudest over back

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46
Q

Which cardiac enzyme is best when looking for re-infarction?

A

CK-MB as it takes 3-4 days to return to normal

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47
Q

How long does Troponin T take to return to normal levels?

A

10 days

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48
Q

ECG Fx of hypokalaemia

A 
U waves (deflection after T wave)
PR prolongation
ST depression
QT elongation
Inverted/absent T waves
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49
Q

Which electrolyte abnormality would furosemide cause?

A

Hypokalaemia

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50
Q

Poor prognostic factors in infective endocarditis?

A

Staph infection
Seronegative endocarditis
Valve prosthesis
Low complement levels

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51
Q

Causes of a raised BNP?

A 
Heart failure
CKD with eGFR<60
PE
COPD
Sepsis
Other cardio stuff
Diabetes
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52
Q

What is the mechanism of flash pulmonary oedema secondary to MI?

A

MI leads to acute MV regurg> backflow into LV and LA > pulmonary congestion > pulmonary oedema

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53
Q

AR murmur characteristics

A 
Early diastolic 
Loudest on expiration
Loudest over aorta
Radiates to 4th space
High pitched and blowing
Also presents with collapsing pulse and displaced apex beat
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54
Q

How does bifascicular block appear on ECG?

A

RBBB + LAD

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55
Q

When would you use the three-shock strategy?

A

In witnessed VF/pVT

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56
Q

Three features of autonomic neuropathy?

A
  1. Postural hypotension
  2. Loss of respiratory arrhythmia
  3. Erectile dysfunction
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57
Q

Causes of postural hypotension?

A

Hypovolaemia
Autonomic failure - Diabetes, Parkinson’s/MSA
Drugs: Diuretics, SSRIs, anti-hypertensives, LevoDOPA
Alcohol

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58
Q

STEMI Rx guidelines?

A
  1. All patients receive Aspirin 300mg + Clopi/Ticagrelor (PY212i)
  2. All should go for PCI with unfractionated heparin
  3. Thrombolysis (tPA e.g. alteplase) if PCI not available
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59
Q

ECG findings in hypothermia?

A 
J waves (weird bit after QRS)
QT prolongation
First degree HB
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60
Q

Which vein in the leg might you use for a venous cutdown, and what is its relation to the malleoli?

A

Long saphenous vein which passes anterior to the medial malleolus

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61
Q

NSTEMI Rx guidelines?

A
  1. Aspirin + Prasugel/Ticagrelor + Nitrates/Morphine for all.
  2. PCI + unfractionated Hep if possible.
    2a. If not, Antithrombin e.g. Fondaparinux
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62
Q

What is the mechanism and site of action of thiazide diuretics?

A

Sodium reabsorption inhibitor at the proximal end of the DCT

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63
Q

Thiazide diuretic side effects?

A 
Dehydration
Hyponatraemia
Hypokalaemia
Hypercalcaemia
Postural hypotension
IGT
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64
Q

Which infective agents cause endocarditis, and in which groups?

A

S. aureus: COMMONEST cause, particularly seen in IVDUs.
Strep viridans is seen after dental procedures
Staph epidermis is seen after valve surgery
Coxiella is seen in farm workers (causes Q fever)
Streptococcus bovis is seen in colorectal cancer

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65
Q

How long should patients with provoked PEs be anticoagulated for?

A

3 months

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66
Q

What are the first two stages in management of a narrow complex SVT?

A
  1. Valsalva manouvre

2. IV Adenosine

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67
Q

Management of symptomatic bradycardia?

A

IV Atropine (up to 3mg)

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68
Q

Causes of constrictive pericarditis?

A
  1. TB (esp in developing world)
  2. CTDs e.g. scleroderma,
  3. Uraemia secondary to CKD
  4. Radiation
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69
Q

Features of constrictive pericarditis?

A 
Raised JVP 
Peripheral oedema
Bibasal crackles
Dyspnoea
Hepatomegaly
Kussmaul's breathing
Pericardial knock (Loud S3)
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70
Q

Which murmur is associated with collagen disorders?

A

Mitral regurg

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71
Q

Causes of mitral regurg?

A
  1. Acutely post MI
  2. MV prolapse
  3. Infective endocarditis
  4. Rheumatic fever
  5. Congenital
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72
Q

How long before surgery should Warfarin patients hold their medication?

A

5 days

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73
Q

Modified Duke major criteria

A

Positive serology:
2x consecutive positive cultures (Staph/strep)
Coxiella/Bartonella/chlamydia positive serology

Evidence of endocardial involvement:
Positive echocardiogram
New valvular regurgitation

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74
Q

Modified Duke minor criteria

A

Pre-existing heart condition or IVDU
Microbiological evidence which does not meet major criteria
Vascular signs (Major emboli, clubbing, splenomegaly Janeway lesions, splinter haemorrhages)
Immunological signs (Roth spots, Osler’s nodes, glomerulonephritis)
Fever >38.

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75
Q

Diagnostic requirements for IE

A

2x major criteria OR
5x minor criteria OR
1x major AND 3x minor OR
Pathological criteria positive (positive histology at autopsy or cardiac surgery)

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76
Q

Ix for suspected PE in CKD?

A

V/Q scan

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77
Q

Rate control in AF?

A
  1. B blocker
  2. Ca blocker
  3. Digoxin
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78
Q

Rhythm control in AF?

A

Sotalol

Flecanide

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79
Q

Dipyridamole MOA

A

Platelet inhibitor which works by phosphodiesterase

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80
Q

Dipyridamole use?

A

With aspirin after acute ischaemic stroke

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81
Q

Does zopiclone cause orthostatic hypotension?

A

NO!

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82
Q

What is the ALS procedure for VF/VT cardiac arrest?

A

30:2 with defibrillator charging
Shock at >150 joules every 2 minutes, with 1mg IV adrenaline given after the third shock then every 3-5 minutes after that.

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83
Q

How would you manage pulseless electrical activity?

A

1mg adrenaline ASAP as this is not a shockable rhythm.

Continue high quality CPR

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84
Q

What is Wellen’s syndrome?

A

Precordial ‘arrowhead”T wave inversion seen in acute ischaemia in underlying unstable angina

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85
Q

ECG features of posterior MI?

A

Tall R waves in V1 and V2

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86
Q

What is Eisenmenger’s syndrome and what is its management?

A

The reversal of a left-to-right shunt due to pulmonary hypertension.
Can only be managed with a heart-lung transplant.

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87
Q

PND is a sign of left or right sided HF?

A

Left

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88
Q

What are the side effects of loop diuretics?

A 
Hypokal/nat/cal/magnesaemia
Ototoxicity
Gout
Renal impairment
Hyperglycaemia
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89
Q

What class of medication should be given to MI patients with high cardiovascular risk who are due PCI within 96 hours of admission?

A

Gp11b/111a inhibitors e.g. Abciximab and Tirofiban

90
Q

What is the precise site and MOA of furosemide

A

Na-K-Cl co transporter inhibitor in the thick ascending loop of Henle

91
Q

What should you do if high suspicion of PE but delay in CTPA?

A

Give treatment dose of LMWH while waiting for scan

92
Q

Commonest cause of S3 in under and over 30s?

A

Under: Physiological
Over: LHF

93
Q

What heart sound does HOCM cause?

A

S4

94
Q

How should glycaemic control be managed in post MI patients?

A

Stop all diabetic medications and place on sliding scale insulin infusion with regular BMs aiming for <11mmol

95
Q

What is the medical management for Torsades de Pointes?

A

IV MgSO4.

96
Q

What is the progression of ECG changes in MI?

A

Mins - hyperacute T waves
Mins-Hours - ST elevation
Hours- Days - Q waves
Days- months - T inversion

97
Q

In which leads is it normal to see T wave inversion?

A

aVL, III, V1

98
Q

What are the features of aortic coarctation in infants and in adults?

A

Infancy - HF with HTN, ESM and weak femorals

Adult - Hypertension, RF delay, mid systolic murmur

99
Q

What does persistent ST elevation after an MI indicate, and what is the main concerning complication of this?

A

Left ventricular aneurysm which may result in thromboembolic stroke

100
Q

When would you see a J wave?

A

In a hypothermic patient after the QRS complex

101
Q

Outline the cardiac causes of syncope

A

Arrhythmia - brady/tachy
Structural - valvular, MI, HOCM
Other - PE

102
Q

How does carotid sinus hypersensitivity cause syncope, and how is it diagnosed?

A

Carotid sinus massage involves massaging the carotid for 5 seconds which stimulates baroreceptors and the PNS. This increases vagal tone and SA/AV nodes resulting in a BP and HR drop. If the baroreceptor is hypersensitive - as it is in CSH - this can cause a ventricular pause, diagnostic when >3 seconds in duration

103
Q

What are some causes of long QT syndrome?

A

Congenital - Romano Ward
Drugs - Amiodarone, sotalol, SSRIs, TCAs
Electrolyte abnormalities

104
Q

What is the management of long QT syndrome?

A

B-blockers NOT sotalol (causes long QT)

105
Q

What is the acute management of an SVT?

A

Valsalva manouvre/carotid sinus massage
IV adenosine if above fails (CI inasthmatics)
DC cardiovert

106
Q

What investigation should patients with acute pericarditis have?

A

TTE

107
Q

What is the ATLS management of PEA or asystole?

A

CPR with rhythm checks every two minutes

1mg adrenaline ASAP then every 3-5 minutes

108
Q

What is the most common accompanying feature of an aortic dissection?

A

Hemiplegia

109
Q

How do you manage a choking patient/

A

If patient able to talk - encourage coughing first then proceed to…

If patient unable to talk - 5 back blows then 5 abdo thrusts and repeat

110
Q

What pulse is seen in LVF?

A

Pulsus alternans, where the upstroke varies between strong and weak

111
Q

What is the target INR for patients with 1 or many occasions of VTE?

A

1 - INR 2.5

more than 1 - INR 3.5

112
Q

What is the management ladder for angina?

A

Aspirin and statin as standard
GTN for acute attacks
BB or CCB next
Beta blockers should not be prescribed with verapamil (CHB)

113
Q

How do you manage a broad complex tachyarrhythmia?

A

No adverse features - IV amiodarone

Adverse features - DC cardiovert

114
Q

Name 4 CYP450 inducers

A

Carbamazepine
Phenytoin
Barbituates
St Johns Wart

115
Q

Name 6 CYP450 inhibitors

A 
Cipro
Erythro/clarithromycin
Isoniazid
Cimetidine
Omeprazole
Amiodarone
116
Q

What are the features of cardiac tamponade?

A

Falling BP
Rising JVP
Muffled heart sounds
(Becks triad)

117
Q

Which artery is blocked in a lateral MI?

A

Left circumflex

118
Q

What other investigation must be done before a CTPA?

A

CXR

119
Q

What may occur in patients with an ostium secundum septal defect?

A

Emboli may pass from the right sided circulation the left causing a stroke

120
Q

Which cardiac drug predisposes to hyperuricaemia?

A

Thiazides

121
Q

What murmur is seen in VSD patients?

A

PSM with loud P2

122
Q

What QRISK2 score warrants statin prescription?

A

> 10%

123
Q

What investigation should be done in a patient with GFR 30 and a Wells score of 9?

A

V/Q scan (CTPA contraindicated due to contrast)

124
Q

How does nicorandil work and what is it used for?

A

K channel activator with vasodilatory effects used in angina patients

125
Q

What is the management of a patient with symptomatic Mobitz type two type two heart block?

A

Pacemaker insertion

126
Q

What is the definitive of WPW?

A

Accessory pathway ablation

127
Q

Kussmal sign vs pulsus paradoxus?

A

Kussmal sign is a rise in JVP on inspiration, while pulsus paradoxus is a drop in BP on inspiration

128
Q

What are some of the side effects of beta blockers?

A

Bronchospasm
Insomnia/fatigue
Cold peripheries
Impotence

129
Q

What should be done in the event of chest pain or haemodynamic instability following PCI for MI?

A

CABG - as this likely indicates that the procedure has failed and that myocardial ischaemia is continuing

130
Q

Outline the NYHA HF classification

A

1 - no sx
2 - mild sx
3 - mod sx
4 - severe, sx at erst

131
Q

You are asked to urgently review a 61-year-old female on the cardiology ward due to difficulty in breathing. On examination she has a raised JVP with bilateral fine crackles to the mid zones. Blood pressure is 100/60 mmHg and the pulse is 140-150 and irregular. ECG confirms atrial fibrillation. What is the most appropriate management?

A

This is a narrow complex tachycardia with HF as an ‘adverse sign’ so DC cardioversion is indicated

132
Q

What should be done or patients on warfarin requiring emergency surgery?

A

If can wait 6-8 hours - 5mg vit K IV

If cannot wait - Four factor prothrombin complex

133
Q

What is trifascicular block?

A

RBBB
Left axis deviation
1st degree HB

134
Q

Which antihypertensives cause hyperkalaemia, and which cause hypokalaemia/

A

Hyper - ACEi, ARB

Hypo - Thiazides, Loop diuretics

135
Q

What drug class is Indapamide?

A

Thiazide diuretic

136
Q

What drug class is Bumetanide?

A

Loop diuretic

137
Q

What are the common adverse effects of thiazide diuretics?

A 
Dehydration
Gout
Postural hypos
HypoNa 
HypoK
HypErCa with hypocalcuria
IGT
Impotence
138
Q

S3 indicates?

A

DCM in older patients

Normal if under 30

139
Q

Which drugs improve mortality in HF?

A

ACEi
BBlockers
Spiro

140
Q

Next HTN drug if already on A, C and D?

A

Alpha or Beta blocker

141
Q

Which valve is commonly affected with IE in IVDU?

A

Tricuspid

142
Q

What should be given to patients with major risk factors before a long haul flight?

A

Anti-embolic stockings

143
Q

Which artery is commonly blocked in complete heart block?

A

the posterior interventricular artery which is a branch of the Right Coronary Artery

144
Q

What is the full MOA of aspirin/

A

Inhibits Cox1 to reduce production of thromboxane A2

145
Q

What are some poor prognostic factors in ACS?

A 
Dev/Hx of heart failure
Age>65
Peripheral vascular disease
Hypotension
Elevated cardiac markers
146
Q

What drug type are candesartan, irbesartan etc?

A

ARBs

147
Q

What should be done if BP is >135/85 but <150/90 at first presentation/

A

Ambulatory blood pressure monitoring

148
Q

What should be done for a warfarin patient with major bleeding?

A

Stop warfarin
5mg IV Vit K
Prothrombin Complex Concentrate

149
Q

What should be done for a warfarin patient with INR>8 and minor bleeding?

A

Stop warfarin
Give 1-3mg IV vit K and repeat after 24hrs if necessary
Restart warfarin when INR<5

150
Q

What should be done for a warfarin patient with INR>8 and no bleeding?

A

Stop warfarin
Give 1-5mg oral vit K and repeat after 24 hrs if necessary
Restart warfarin when INR<5

151
Q

What should be done for a warfarin patient with INR 5-8 and minor bleeding/

A

Stop warfarin
Give IV vit K 1-3mg
Restart when INR<5

152
Q

WHat should be done for a warfarin patient with INR 5-8 and no bleeding?

A

Withhold 1-2 doses

Reduce subsequent maintenance dose

153
Q

What dose of IV amiodarone is given initially in ATLS?

A

300mg

154
Q

Which antihypertensives reduce awareness of hypoglycaemia?

A

Beta blockers

155
Q

Which medications should MI PCI patients be discharged on?

A

DAPT
ACEi
Beta blocker
Statin

156
Q

What agents are used for rate control of patients in fast AF?

A
  1. Atenolol
  2. Digoxin
  3. CCBs
157
Q

What agents are used to maintain sinus rhythm in patients with a Hx of AF?

A

Sotalol
Amiodarone
Flecainide

158
Q

What iatrogenic causes of Torsades de Pointes/

A 
Amiodarone
Sotalol
TCAs
Antipsyhotics
Chloroquine
Erythromycin
159
Q

What is the management of TdP?

A

IV Magsulf

160
Q

What are the features of constrictive pericarditis?

A

Dyspnoea
Peripheral oedema
Positive Kussmaul’s sign
Pericardial knock

161
Q

What drug class are Ivabradine, Nicorandil and Ranolazine and when are they used?

A

Long acting nitrates used for angina when CCBs are not tolerated

162
Q

Eismenger presents following VSD/ASD/PDA, with cyanosis, RV failure, haemoptysis and clubbing, but what are the ECG findings?

A

RV hypertrophy

163
Q

OUtline the management of orthostatic hypotension

A

Education and lifestyle advise
Discontinuing vasoactives (nitrates, antihypertensives, neuroleptics, dopamines)
Consider Fludricortisone

164
Q

What should be tried next for angina if not controlled with Beta blockade/

A

CCB

165
Q

Which medication must be temporarily stopped while on a macrolide and why?

A

Statins due to increased risk of rhabdomyolysis

166
Q

A 59-year-old woman presents to the emergency department complaining of a three-day history of new-onset palpitations. She has no structural or ischaemic heart disease. Her heart rate is 120bpm, and she shows no signs haemodynamic compromise. Her ECG shows an irregularly irregular rhythm with the absence of p waves. The consultant recommends elective cardioversion for this patient. Which one of these management plans is the most appropriate for this patient?

A

Bisoprolol and oral anticoagulant therapy for 3 weeks and then electrical cardioversion

167
Q

Where and on what do loop diuretics act?

A

NaKCl cotransporter in the thick ascending limb of the loop of Henle

168
Q

What ECG change is seen in patients with mitral stenosis?

A

P mitrale (L atrial hypertrophy)

169
Q

Young male smoker with limb ischaemia think…

A

Buerger’s

170
Q

Which antianginal might patients develop a tolerance to?

A

Isosorbide mononitrate

171
Q

A 52-year-old male presents with tearing central chest pain. On examination he has an aortic regurgitation murmur. An ECG shows ST elevation in leads II, III and aVF.

A

Proximal aortic dissection

172
Q

What should you do if you see new onset LBBB in the context of chest pain?

A

PCI/thrombolysis

173
Q

Which drugs are used for chemical cardioversion in AF?

A

Amiodarone + Flecainide

174
Q

What should be given in a stable SVT when adenosine 6mg fails?

A

Adenosine 12mg

175
Q

What is the management of symptomatic bradycardia if 6 doses of atropine fails?

A

External pacing

176
Q

What is the time limit for primary PCI?

A

2 hours

177
Q

What are the common side effects of amiodarone?

A 
Bradycardia
Thyroid dysfunction
Pulm fibrosis
Hepatitis/fibrosis
Jaundice
Slate grey skin
N&amp;V
Constipation
178
Q

Atropine
Amiodarone
Adenosine
When do you use them?

A

Atropine is for symptomatic bradys
Amiodarone is for VT/VF
Adenosine is for SVTs

179
Q

What is the MOA of LMWH?

A

Activates antithrombin 3

180
Q

What is the BP target for T2DM?

A

<140/80

181
Q

What is the commonest cause of mitral stenosis?

A

Hx of RhFever

182
Q

What is the acute management of a PE?

A

LMWH

Unless massive PE or hypotensive in which case unfractionated heparin and thrombolysis is indicated

183
Q

What is the secondary prevention of a PE?

A

Warfarin for 3 months (extend if unprovoked PE)

If active cancer then use LMWH for 6 months

184
Q

What may cause a falsely low BNP?

A

ACEi

185
Q

What is the protocol for a witnessed cardiac arrest while on a monitor?

A

Up to 3 successive shocks before CPR

186
Q

What investigation is first line for stable angina?

A

Contrast enhanced coronary CT angiography

187
Q

What access is required for administration of adenosine?

A

Large bore cannula in large calibre vein or (ideally) centrally

188
Q

What is the MOA of alteplase?

A

Converts plasminogen to plasmin

189
Q

When should young type 1 diabetics be offered primary CV prevention?

A

Older than 40 OR
Diavetic more than 10 years OR
Established nephropathy OR
Other CV riskf actors

190
Q

WHat should be added to hypertensive pts already on A + C + D with a K+ <4.5?

A

Spiro

191
Q

WHen do you use flecainide and when do you use amiodarone for chemical cardioversion of AF?

A

Use amiodarone if there is evidence of underlying structural disease

192
Q

What class of drug is contraindicated in aortic stenosis?

A

NItrates

193
Q

When should statin treatment be discontinued (LFTs)

A

If transaminases are persistently above 3 times the upper limit

194
Q

Inheritence pattern of HOCM?

A

AD

195
Q

What is the main cause of sudden death in HOCM patients?

A

Ventricular arrhythmia

196
Q

What are the features of hypercalcaemia?

A

Bones stones groans moans

Shortened QT interval

197
Q

What is the optimal management of an ascending aortic aneursym?

A

Aortic root replacement

198
Q

Which valvular disease is associated with PKD?

A

Mitral valve prolapse

199
Q

What rogue Xray thing is seen in CoA?

A

Notching of the inferior border of the ribs

200
Q

A 65-year-old man calls an ambulance as he has central crushing chest pain that radiates to his left arm and jaw. As he arrives at the emergency department his heart rate is found to be 50/min. An ECG is performed which shows ST elevation and bradycardia with a 1st-degree heart block.

Given the history, which of the following are the leads will most likely show the ST elevation?

A

Inferior

201
Q

What time of day should statins be taken at?

A

Night

202
Q

What is the BP target for diabetics with signs of end organ damage?

A

<130/80

203
Q

What regarding blood products is indicated in patients with suspected ruptured AAA?

A

X match 6 units

204
Q

How might a DVT cause a stroke and not a PE?

A

ASD

205
Q

Give some important side effects of furosemide

A 
Hypotension
HypoNaKMgCa -> osteoporosis
Ototoxicitiy 
Renal impairment
Gout
206
Q

Give two contrainidications to statin therapy

A

Pregnancy

Macrolides

207
Q

What condition can cause a bisferiens pulse?

A

HOCM

208
Q

True or false ; warfarin is safe for use in breastfeeding women

A

True

209
Q

What investigations should be done before starting a patient on amiodarone?

A

FBC
TFT
UNE
CXR

210
Q

A 65-year-old lady with long-term type II diabetes mellitus had been suffering from recurrent falls due to orthostatic hypotension. During the table tilt test, it was noted that her systolic blood pressure reduced by 30mmHg. Her heart rate remained unchanged despite the drop in the blood pressure. She drinks a glass of wine on rare occasions.

Which of the following contributes to the lack of heart-rate response to standing in this patient?

A

Diabetes

Dehydration/anaemia cause an exaggerated increase in HR

211
Q

What is the most common cause of death in patients following MI?

A

VF

212
Q

What is the management of IE causing CCF?

A

Emergency valve replacement surgery

213
Q

True or false; furosemide increases life expectancy in HF

A

False

214
Q

What is Subclavian steal syndrome?

A

Posterior circulation symptoms (dizziness and vertigo) during exertion of an arm

215
Q

What are the side effects of GTN sprays?

A

Hypotension
tachycardia
headaches

216
Q

One day following a thrombolysed inferior myocardial infarction a 72-year-old man develops signs of left ventricular failure. His blood pressure drops to 100/70mmHg. On examination he has a new early-to-mid systolic murmur.

A

Papillary muscle rupture leading to acute mitral regurg

217
Q

What are the diagnostic criteria for Osler Weber Rendu syndrome (HHT)?

A

Epistaxes
Telangiectasiae at multiple sites
Visceral lesions
FHx

218
Q

What is the definitive management of an uncomplicated descending aortic dissection?

A

Beta blockade and analgesia alone

219
Q

Standard post ischaemic stroke management/secondary prevention?

A

Asp 300 for 2 weeks then clopi 75 lifelong

220
Q

A 58-year-old female on the respiratory ward was admitted with a pulmonary embolism one week ago and was started on warfarin at the time of diagnosis. She was covered with low molecular weight heparin until the INR was > 2 for 24 hours. For the past week she has been taking 4mg of warfarin and her INR four days ago was 2.2. Her INR has been checked today and is 1.3.

What is the most appropriate action to take?

A

Increase warfarin to 6mg and start LMWH till INR>2

Year 6 Passmed (22 decks)

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